Why Texas should not expand Medicaid

America is facing an entitlement spending crisis, with unfunded liabilities for Medicare, Social Security and Medicaid approaching $100 trillion. This is an outrageous situation that threatens our fiscal and economic well-being as a country. And few brave souls are tackling these problems to find real solutions. Maybe we should start with the smallest of the big three entitlement programs: Medicaid.

Medicaid spending has quadrupled over the past four decades (measured in constant 2012 dollars) and reached $282 billion in 2011. The program continues to swallow up a larger share of state budgets, leaving less money for things like education and infrastructure. In short, Medicaid is on an unsustainable path — unless we offer innovative ideas to solve the spending problem and improve the program’s quality of care.

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Here in Texas, the Medicaid program truly needs fundamental reform. The status quo leaves enrollees with inadequate access to providers and poor health outcomes. Part of the reason for this is that many Texas physicians, particularly specialists, won’t accept Medicaid patients because payments from the state aren’t even enough to cover the cost of providing care.

With an uninsured patient, providers can and do work out payment plans and discounts to help cover costs, but federal law does not allow them to charge Medicaid patients anything — even the Medicaid patients who do have the means to contribute something toward the cost of their care.

Bottom line is that the status quo doesn’t make sense for providers or patients. Neither does the Medicaid expansion called for by ObamaCare, which seeks to double down on a failed system while offering no constructive path to reform. As Texans, we can do better.

Both of us, in our previous lives as legislators, have tackled tough entitlement spending problems like health care and welfare. Based on what we have learned and experienced, we know Medicaid reform will not be easy. But we also know that it simply must be done. That is why we are proposing the following plan to reform Medicaid and put it on a sustainable path that does not drive us into bankruptcy in the near future.